综合医院抑郁焦虑障碍患者躯体症状与躯体疾病诊断分布研究

目的了解综合医院门诊患者躯体症状和躯体疾病诊断特点,及其与抑郁和焦虑障碍的关系。方法横断面现况调查设计。有8 487例接受患者医院焦虑抑郁量表(HADS)筛查且详细记录门诊过程,2 456例HADS≥8分的患者接受国际神经精神科简式访谈问卷(MINI5.0.0)的精神科诊断评估,6 771例纳入分组比较。结果抑郁和(或)焦虑障碍患者的患病风险随躯体症状增多而升高〔OR抑郁障碍=1.51～2.11,OR焦虑障碍=1.75～1.87,OR抑郁和(或)焦虑障碍=1.57～2.03,P<0.001〕;抑郁组、焦虑组及抑郁和(或)焦虑组患者主诉疲倦〔OR抑郁障碍=1.98,OR焦虑障碍=1.67,OR抑郁和(或)焦虑障碍=1.88〕、虚弱无力〔OR抑郁障碍=2.18,OR焦虑障碍=2.14,OR抑郁和(或)焦虑障碍=1.95〕、失眠〔OR抑郁障碍=2.85,OR焦虑障碍=2.88,OR抑郁和(或)焦虑障碍=2.95〕、思维迟钝(OR抑郁障碍=2.36)、食欲不振〔OR抑郁和(或)焦虑障碍=1.40〕、情绪不稳〔OR抑郁障碍=3.42,OR焦虑障碍=3.33,OR抑郁和(或)焦虑障碍=2.10〕和焦虑〔OR抑郁障碍=5.10,OR焦虑障碍=5.30,OR抑郁和(或)焦虑障碍=5.49〕的比例高于诊断阴性组,差异均有统计学意义(P<0.05);有疲倦、虚弱无力、失眠、情绪不稳和焦虑等任一躯体/情绪症状或症状叠加患者的抑郁、焦虑的患病风险高于无此主诉的患者〔OR抑郁障碍=2.22～5.67,OR焦虑障碍=2.02～4.35,OR抑郁和(或)焦虑障碍=2.13～4.15〕;抑郁、焦虑组患者被诊断为心血管神经官能症〔OR抑郁障碍=3.81,OR焦虑障碍=2.97,OR抑郁和(或)焦虑障碍=2.82〕、胃食管反流病〔OR抑郁障碍=1.44,OR焦虑障碍=1.51,OR抑郁和(或)焦虑障碍=1.46〕、末梢神经痛〔OR抑郁障碍=1.71,OR焦虑障碍=1.99,OR抑郁和(或)焦虑障碍=1.73〕、胃炎〔OR抑郁障碍=1.48,OR抑郁和(或)焦虑障碍=1.33〕、盆腔炎〔OR抑郁障碍=2.17,OR抑郁和(或)焦虑障碍=1.82〕、心血管待查〔OR焦虑障碍=1.82,P=0.003〕等躯体诊断的比例高于诊断阴性患者,高血压〔OR抑郁障碍=0.72,OR焦虑障碍=0.58,OR抑郁和(或)焦虑障碍=0.65〕、外阴阴道炎〔OR抑郁障碍=0.59,OR焦虑障碍=0.63,OR抑郁和(或)焦虑障碍=0.64〕和冠心病(OR焦虑障碍=0.48)的比例低于诊断阴性患者,差别均有统计学意义(P<0.05)。结论有抑郁、焦虑障碍的综合医院门诊患者存在较多的主诉,且主诉的症状类型呈现一定特点,症状数多且疲倦、虚弱无力、失眠、情绪不稳和焦虑等多种症状叠加时提示抑郁或焦虑障碍的可能,可作为各科医生识别抑郁或焦虑障碍的警示,并在门诊诊断时注意排除。

Distribution of Physical Symptoms and Diagnoses in Patients with Depression or Anxiety Disorders in General Hospitals

Objective To examine the patterns of physical symptoms and diagnoses among outpatients in general hospitals and their relationship with depression or anxiety disorders.Methods In this cross-sectional survey,8487 subjects were screened by Hospital Anxiety and Depression Scale(HADS),and their physical symptoms and diagnoses were all recorded during routine clinical visit.Furthermore,2456 subjects with an HADS score ≥8 evaluated with Mini International Neuropsychaitric Interview(MINI5.0.0) by psychiatrists.Data of 6771 subjects were included in the comparative statistical analysis.Results The risk of depression or anxiety disorder significantly increased with the increase of physical symptoms(ORdepression=1.51~2.11,ORanxiety=1.75~1.87,ORdepression/anxiety=1.57~2.03,P<0.001).Outpatients with depression or anxiety disorders were more likely to complain fatigue(ORdepression=1.98,ORanxiety=1.67,ORdepression/anxiety=1.88,P=0.000~0.002),weakness(ORdepression=2.18,ORanxiety=2.14,ORdepression/anxiety=1.95,P=0.000 ~ 0.001),insomnia(ORdepression=2.85,ORanxiety=2.88,ORdepression/anxiety=2.95,P<0.001),slow thinking(ORdepression=2.36,P=0.037),loss of appetite(ORdepression/anxiety=1.40,P=0.043),instable mood(ORdepression=3.42,ORanxiety=3.33,ORdepression/anxiety=2.10,P≤0.001),and anxiety(ORdepression=5.10,ORanxiety=5.30,ORdepression/anxiety=5.49,P≤0.001) than those without,with statistically significance.The risk of depression or anxiety disorder was significantly higher in outpatients with coexisting physical symptoms(fatigue,weakness,or insomnia) and mental symptoms(instable mood or anxiety) than in those with none of the symptoms(ORdepression=2.22 ~ 5.67,ORanxiety=2.02 ~ 4.35,ORdepression/anxiety=2.13 ~ 4.15,P<0.001).Patients with depression or anxiety were more frequent to have physical diagnosis of cardiovascular neurosis(ORdepression=3.81,ORanxiety=2.97,ORdepression/anxiety=2.82,P=0.001-0.025),gastro-esophageal reflux disease(ORdepression=1.44,ORanxiety=1.51,ORdepression/anxiety=1.46,P≤0.001),peripheral neuralgia(ORdepression=1.71,ORanxiety=1.99,ORdepression/anxiety=1.73,P<0.001),gastritis(ORdepression=1.48,ORdepression/anxiety=1.33,P=0.004 ~ 0.021),pelvic inflammatory disease(ORdepression=2.17,ORdepression/anxiety=1.82,P=0.005 ~ 0.027) or cardiovascular unknown origin(ORanxiety=1.82,P=0.003) than those without,while diagnosis of hypertension(ORdepression=0.72,ORanxiety=0.58,ORdepression/anxiety=0.65,P=0.000 ~ 0.013),coronary heart disease(ORanxiety=0.48,P=0.021),and vulva vaginitis(ORdepression=0.59,ORanxiety=0.63,ORdepression/anxiety=0.64,P=0.000 ~ 0.005) were significantly less frequent.Conclusion Outpatients with depression/anxiety disorders have more complaints,which usually show certain features.They tend to have multiple symptoms and are often coexist with physical and mental symptoms such as fatigue,weakness,insomnia,instable mood,or anxiety,which may serve as an alert for depression or anxiety disorder.